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Improving Child Survival and Maternal Health Requires Range of Interventions, Including Family Planning

June 24, 2014

In 2012, an estimated 287,000 women died from pregnancy-related causes, and 6.6 million children did not live to see their fifth birthday. The vast majority of these deaths could have been prevented by providing basic maternal and newborn care and high-quality family planning services. To address these ongoing challenges and to review recent progress, the U.S. Agency for International Development (USAID), in partnership with the governments of India and Ethiopia and other key actors, is convening a high-level forum on June 25 called Acting on the Call: Ending Preventable Child and Maternal Deaths.

Since 1990, deaths among children younger than five have been reduced by one-half, and pregnancy- and childbirth-related deaths among women have been reduced by nearly the same proportion. While we celebrate these significant achievements, we must also acknowledge the glaring and ongoing disparities yet to be addressed: Children born in Sub-Saharan Africa are more than 17 times as likely to die before the age of five as children in developed countries1, and a woman’s lifetime risk of maternal death is one in 160 in developing countries, compared with just one in 3,700 in developed countries.2

Just 64% of developing-country women give birth in a health facility, and nearly half do not make the minimum of four recommended antenatal visits. This translates to an estimated 44 million women lacking delivery care and 55 million lacking antenatal care. Likewise, 222 million women in developing countries are sexually active and want to avoid pregnancy but are not using modern contraceptives.

It is not just the disparity between rich and poor nations that is alarming; there are increasing disparities among developing countries, as well. Just half of women in the poorest countries deliver in a health facility, compared with 94% in higher-income developing countries. And in the poorest countries, fewer than half of women giving birth receive appropriate antenatal care, compared with 81% in higher-income developing countries. If the goal is to end preventable child and maternal deaths, efforts must be greatly intensified in the poorest countries where the needs, as well as the challenges to meeting those needs, are the greatest.

These efforts must include significant investments in family planning services. These investments will act as a catalyst: Enabling women to space their births and avoid pregnancies that they do not want reduces deaths among mothers and newborns at a faster rate—and a lower cost—than could be achieved with stand-alone investments in maternal and newborn care. Preventing unintended pregnancies also leaves more resources available for providing quality pregnancy and delivery care and reduces demand for unsafe abortions.

Providing the WHO–recommended minimal level of antenatal, delivery, newborn and postnatal care to all women in developing countries would require doubling current expenditure levels to $24 billion, the vast majority of which would need to be directed to the 69 poorest countries. While significant, this investment would be modest in relation to the remarkable returns it would achieve for women, families, communities and, ultimately, nations.3

1World Health Organization (WHO), Children: reducing mortality, fact sheet, No. 178, 2013, <http://www.who.int/mediacentre/factsheets/fs178/en/>, accessed June 23, 2014.2WHO, Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division, Geneva: WHO, 2014.3Forthcoming Guttmacher research to be released later this year will contain new estimates of the synergistic impact and cost savings of simultaneous investments in family planning and maternal and newborn care.